PROVIDENCE FACEY MEDICAL FOUNDATION
NPI 1194083824
Clinic/Center - Ambulatory Surgical in Mission Hills, CA

Q: What is Providence Facey Medical Foundation's NPI number?

The NPI number for Providence Facey Medical Foundation is 1194083824. It was assigned to this organization in the NPPES registry on May 1, 2012. The provider is doing business as Facey Endoscopy Center.

Q: What is Providence Facey Medical Foundation's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since May 01, 2012CLIA 05D2129761 · Waiver

11333 SEPULVEDA BLVD, SUITE 3200, MISSION HILLS, CA 91345(818) 837-5776(818) 837-5810 Get Directions Write a Review

NPPES record last updated: May 6, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 6, 2025, Mar 3, 2021 (2 updates tracked since 2021).

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About Providence Facey Medical Foundation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE FACEY MEDICAL FOUNDATION (NPI 1194083824), doing business as Facey Endoscopy Center, is a healthcare organization registered as an ambulatory surgical in Mission Hills, California and active in the NPI registry since May 2012. The organization holds a CLIA Waiver certificate valid through April 24, 2027 and lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1194083824

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NamePROVIDENCE FACEY MEDICAL FOUNDATION

Location Address11333 SEPULVEDA BLVD, SUITE 3200Mission Hills, CA 91345-1116

Mailing AddressFile 50670Los Angeles, CA 90074-0670

Phone(818) 837-5776

Fax(818) 837-5810

Organization SubpartYesParent: Facey Medical Foundation

Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786

Enumeration DateMay 1, 2012

Last NPPES UpdateMay 6, 20252 updates tracked since enumeration

NPPES CertifiedMay 6, 2025

✔ NPI 1194083824 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

11333 SEPULVEDA BLVD, Mission Hills, CA 91345

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Other Names 1

Doing Business AsFacey Endoscopy Center

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2129761

Providence Facey Medical Foundation-Mh · Mission Hills, CA

Active · expires Apr 24, 2027

CLIA Number05D2129761

Laboratory TypePhysician Office

Certificate Effective DateApril 25, 2025

Certificate Expiration DateApril 24, 2027

Laboratory DirectorErik Davydov

Laboratory Phone(818) 869-7073

Laboratory LocationProvidence Facey Medical Foundation-Mh11333 Sepulveda Blvd Ste 1710, Mission Hills, CA 91345

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 05D0558842

Providence Facey Medical Foundation- Mission Hills · Mission Hills, CA

Expired · Jul 31, 2026

CLIA Number05D0558842

Laboratory TypeMedical Group

Certificate Effective DateOctober 4, 2022

Certificate Expiration DateJuly 31, 2026

Laboratory DirectorErik Davydov

Laboratory Phone(818) 869-7220

Laboratory LocationProvidence Facey Medical Foundation- Mission Hills11333 Sepulveda Blvd, Ste 100, Mission Hills, CA 91345

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 05D2044481

Providence Facey Medical Foundation Dba Facey Endoscopy Center · Mission Hills, CA

Expired · Jul 24, 2026

CLIA Number05D2044481

Laboratory TypeOutpatient Endoscopy Ctr

Certificate Effective DateJuly 25, 2024

Certificate Expiration DateJuly 24, 2026

Laboratory DirectorEric Davydov

Laboratory Phone(818) 869-7048

Laboratory LocationProvidence Facey Medical Foundation Dba Facey Endoscopy Center11333 N. Sepulveda Blvd Ste. 3200, Mission Hills, CA 91345

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Biopsy of large bowel using a flexible endoscope 45380

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

110 services110 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

104 services101 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

58 services57 patients

Colorectal cancer screening; colonoscopy on individual at high risk G0105

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

32 services32 patients

Diagnostic exam of large bowel using a flexible endoscope 45378

This procedure, known as a colonoscopy, involves using a flexible tube with a light and camera to examine the large intestine. It helps detect any abnormalities such as polyps or inflammation. It's a standard procedure to ensure gut health.

21 services21 patients

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0121

Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.

15 services15 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SARTHI RAKSHEN SHAH M.D.

Internal Medicine